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endocrine (mine) > adrenal diseases > Flashcards

adrenal diseases Flashcards

1
Q

what is adrenal insufficiency

A

inadequate adrenocortical function

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2
Q

what are the types of adrenal insufficiency

A

primary (acute and chronic)

secondary

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3
Q

what causes secondary adrenal insufficiency, what is most common

A

anything outwith the adrenal gland:

lack of ACTH stimulation
iatrogenic = most common
pituitary/hypothalamic disorder

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4
Q

give an example of an iatrogenic cause of adrenal insufficiency

A

excess exogenous steroids due to medication

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5
Q

what are the cause of chronic primary adrenal insufficiency, what is most common

A 
addison's disease = most common
congenital adrenal hyperplasia 
adrenal TB (rare in uk)
adrenal malignancy (rare)
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6
Q

what are the investigations of adrenal insufficiency

A

CT adrenals

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7
Q

what are the causes of acute primary adrenal insufficiency

A

rapid withdrawal of steroid treatment
massive adrenal haemorrhage
adrenal crisis

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8
Q

what is Addison’s disease

A

type of adrenal hypofunction

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9
Q

what causes Addison’s disease

A

autoimmune destruction of the adrenal cortex

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10
Q

what are the symptoms of Addison’s disease, describe their onset

A 
anorexia
fatigue/weakness 
dizziness
abdominal pain
vomiting and diarrhoea
skin pigmentation = buzzword
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11
Q

why does skin pigmentation happen in Addison’s disease

A

high levels of ACTH cross-react with melanocyte receptors

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12
Q

what does decreased mineralocorticoids cause in Addison’s disease

A

hyperkalaemia

hypotension/postural hypotension

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13
Q

what does decreased glucocorticoids cause in Addison’s disease

A

hyopglycaemia

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14
Q

what investigations should you do in what does in Addison’s disease

A

Na and K levels
ACTH levels
short Synacthen test
adrenal antibodies

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15
Q

what level of ACTH would you expect in Addison’s disease

A

HIGH

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16
Q

what levels of Na and K would you expect in Addison’s disease

A

low Na

high K

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17
Q

what should make you suspect Addison’s disease until proven otherwise

A

low Na

high K

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18
Q

when would you treat Addison’s disease

A

as soon as its suspected, don’t wait for diagnosis to be confirmed

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19
Q

what is the treatment of Addison’s disease

A

hydrocortisone

fludrocortisone

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20
Q

what are the sick day rules surrounding hydrocortisone treatment in Addison’s disease

A

Temp >38 = hydrocortisone dose doubled

Temp >39 = hydrocortisone dose tripled

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21
Q

when would hydrocortisone be given IV in Addison’s disease

A

if patient is systemically unwell

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22
Q

what must be done when giving fludrocortisone

A

monitor BP

monitor K

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23
Q

what is the treatment of adrenal crisis

A

ASAP:

IV saline
IV hydrocortisone

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24
Q

what is adrenal crisis

A

severe adrenal insufficiency

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25
Q

what is congenital adrenal hyperplasia

A

rare autosomal recessive condition associated with enzyme defects in the steroid pathway

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26
Q

what are the two types of congenital adrenal hyperplasia

A

classical

non-classical

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27
Q

what are the investigations of congenital adrenal hyperplasia

A

genetic mutation analysis

basal or stimulated 17-OH progesterone

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28
Q

what is the treatment of congenital adrenal hyperplasia in adults

A

control androgen excess
restore fertility
avoid steroid over-replacement

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29
Q

what is the treatment of congenital adrenal hyperplasia in children

A

glucocorticoid replacement = suppresses ACTH
mineralocorticoid replacement in some
surgical correction of genitals

30
Q

what are the symptoms of classical congenital adrenal hyperplasia

A 
female = genital ambiguity 
male = scrotal discolouration

poor weight gain
adrenal insufficiency (around 2-3 weeks)
biochemical pattern similar to Addison’s

31
Q

what are the symptoms of non-classical congenital adrenal hyperplasia

A 
Hirsute
Acne
Oligomenorrhoea
Precocious puberty
Infertility or sub-fertility
32
Q

what symptoms would you expect in a patient lacking in CRH or ACTH

A

similar to addison’s but will have pale skin and intact aldosterone production

33
Q

what is the treatment of a lack or CRH /ACTH

A

hydrocortisone replacement

34
Q

what is cushing’s syndrome e

A

excess of cortisol

35
Q

how is mainly affected by cushings

A

women aged 20-40

36
Q

what causes cushings syndrome

A 
pituitary adenomas
adrenal adenomas 
ectopic ACTH production e.g. lung cancer
alcohol
steroid medication
37
Q

what is excess cortisol caused by a pituitary adenoma known as

A

cushings disease

38
Q

what is the difference between cushings syndrome and cushings disease

A 
syndrome = caused by anything resulting in high cortisol levels 
disease = caused by high cortisol levels due to a pituitary adenoma
39
Q

what are the symptoms of cushings syndrome

A 
proximal myopathy/wasting 
osteoporosis 
thin skin = easy bruising & striae 
diabetes
central obesity 
high BP
virilism
hirsuitism 
acne
olgio/amenorrhoea
40
Q

what is the investigations of cushings syndrome

A 
high dose oral exogenous steroid (dexamethasone)
low dose dexamethasone
overnight dexamethasone suppression test
24hr urine collection
diurnal cortisol variation
41
Q

what is the gold standard investigation for cushings, what results would you expect

A

low dose DST

cortisol <50 = not cushings
cortisol >130 = defo cushings

42
Q

what is the treatment for cushings caused by a pituitary issue

A

Hypophysectomy and
external radiotherapy if recurs
Bilateral adrenalectomy

43
Q

what is the treatment for cushings caused by an adrenal issue

A

adrenalectomy

44
Q

what is the treatment for cushings caused by an ectopic issue

A

remove source

bilateral adrenalectomy

45
Q

what drugs can be used to treat cushings

A

Metyrapone
Ketoconazole
Pasireotide LAR = somatostatin analogue

46
Q

when would you prescribe drugs in cushings

A

if all else fails or while waiting for radiotherapy to work

47
Q

what is primary aldosteronism

A

autonomous production of aldosterone independent of its regulators

48
Q

what are the regulators of aldosterone

A

angiotensin II

K+

49
Q

what are the causes of primary aldosteronism, what is most common

A

adrenal adenoma
bilateral adrenal hyperplasia = most common
unilateral hyperplasia
genetic mutations

50
Q

what is primary aldosteronism caused by adrenal adenoma called

A

Conn’s syndrome

51
Q

what are the symptoms of primary aldosteronism

A

significant hypotension
hypokalaemia
alkalosis

52
Q

what are the investigations of primary aldosteronism

A

ARR-aldosterone to renin ratio, if raised do saline suppression test to confirm PA
adrenal CT
adrenal vein sampling

53
Q

what is the treatment of primary aldosteronism caused by an adrenal adenoma (conn’s)

A

surgery = unilateral laparoscopic adrenalectomy

54
Q

what is the treatment of primary aldosteronism caused by bilateral hyperplasia

A

MR antagonist = spironolactone or eplereone

55
Q

describe an adrenocortical adenoma

A

well circumscribed, encapsulated lesion composed of cells resembling adrenocortical cells

yellow surface

56
Q

describe an adrenocortical carcinoma

A

large
frequent, abnormal mitoses
lack of clear cells
capsular or vascular invasion

57
Q

what is phaeochromocytoma, where does it originate

A

neuroendocrine tumour of the medulla of the adrenal gland, originating in the chromaffin cells

58
Q

what does phaeochromocytoma secrete

A

catecholamines

59
Q

what is a phaeochromocytoma located outside of the adrenal called

A

paraganglioma

60
Q

why is a phaeochromocytomadark brown in colour

A

potassium dichromate causes oxidation of catecholamines within tumour

61
Q

what is the classical triad of symptoms of phaeochromocytoma

A

hypertension
headache
sweating

62
Q

what are the symptoms of phaeochromocytoma

A 
hypertension
headache
sweating
palpitations
SOB
consitpation
anxiety/fear
weight loss
63
Q

what is phaeochromocytoma associated with

A

MEN2
Von-hippel-lindau syndrome
Neurofibromatosis

64
Q

what are the two purposes of the investigations of  phaeochromocytoma

A

confirm catecholamine excess

identify source of excess catecholamines

65
Q

what investigations confirm excess catecholamines in phaeochromocytoma

A

2 x 24hr catecholamines or metanephrins in urine

catecholamines in plasma

66
Q

what are the issues in trying to identify catecholamine excess

A

they are naturally raised in HF

catecholamine secretion is episodic

67
Q

what investigations identify source of raised catecholamines in phaeochromocytoma

A

MIR
MIBG
PET scan

68
Q

what is the treatment of phaeochromocytoma

A

alpha blocker THEN add beta blocker
surgery
chemo if malignant

69
Q

what alpha blocker is used to treat phaeochromocytoma

A

phenoxybenzamine

70
Q

what beta blocked can be used to treat phaeochromocytoma

A

propanolo, atenolol, metoprolol

71
Q

what is a neuroblastoma

A

rare tumours composed of primitive appearing cells which can show maturation and differentiation towards ganglion cells.

72
Q

where do neuroblastoma arise

A

40% adrenal medulla

the rest are mainly along the sympathetic chains

endocrine (mine) (12 decks)

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